01 Sep 2013

Berita Anestesiologi - September 2013

JILID 17 BIL 3 SEPTEMBER 2013

Table of Contents

 

Message from the President of the MSA

Dear Colleagues and Friends,

It is with great pleasure that I continue my series of "President’s Message" to bring forth updates and information on what is happening in the Society and at large.

AOSRA-PM: 19th-22nd June 2013 Pullman Kuching

The AOSRA-PM concluded on 22nd June 2013 on a high note. It was attended by 999 delegates. I would like to acknowledge the concise scientific programme coordinated by Professor Marzida Mansor and her team for the AOSRA-PM 2013. I must commend them on the simultaneous workshops that were held as an independent track throughout the conference. This sets the medical officers and trainees on a learning path.

I would like to trace the history of AOSRA-PM. It was started by a group of anaesthestists led by Dr Say-Wan Lim during the 1989 ASEAN Congress in Manila, Philippines. Dr Say-Wan Lim was the first President of the Board of Directors of AOSRA. Dr Ramani Vijayan has presented a wonderful insight to his contributions to anaesthesia and the development of regional anaesthesia and pain medicine in the Asia Pacific Region in the inaugural Say-Wan Lim Oration.

The AOSRA-PM Gala Night was a glitzy night with delegates dressed to their hilt in gold and black for their rendezvous in gold. The turnout was amazing! In conjunction with the Gala Night, the 50th Golden Jubilee Anniversary of the MSA was celebrated with the launch of the much awaited book on the 'History of Anaesthesia in Malaysia'.

The award for the best dressed lady of the night went to Dr Wendy Teoh from Singapore and the best dressed gentleman went to Dr F Puhringer from Germany. The following announcements were made:

  • The MSA-AZ YIA Free Paper Award went to Dr Kiung Sze Ting from UMMC
  • The MSA Award 2013 went to Dr Ricky Aditya from Indonesia
  • The Poster Awards – 1st place went to Dr David Leong Wei Jie, 2nd to Dr Hui Mun Tsong and 3rd to Dr Mohd Rohaizat Zamri.

I would like to take this opportunity to congratulate Datin Dr V Sivasakthi, the Organising Chairperson for this thumping success. I would also like to thank the two emcees for the night, Dr Kok Meng Sum and Dr Abraham Philips. Overall, the conference was a great success. This success has been acknowledged by our invited speakers and delegates who have sent many emails and letters of appreciation.

"History of Anaesthesia in Malaysia" Book

The book was written by Dr Alexander Issac Gurubatham and Dato’ Dr A Damodaran. The book captures the journey of anaesthesia from its very early beginnings, to the first anaesthetic administered in Malaysia in 1847 and the journey of MSA for the last 50 years. I wonder how many people know that the first Malaysian anaesthetist was the late Dato’ Dr Frank Rajendram Bhupalan and that the first anaesthetic was performed in Malacca. The “History of Anaesthesia” book is free to all MSA members and can also be purchased at RM50. I take this opportunity to congratulate and say ‘Thank You’ to Dr A I Gurubatham and Dato' Dr A Damodaran for all the time and effort to produce this masterpiece. It is definitely a book to be treasured! Further on this note, please contact the authors or members of the Executive Committee if you have any photographs or information as MSA continues to update its database on its history.

UPCOMING ACTIVITIES

National Anaesthesia Day - Theme: "Your LIFE …We CARE!!"

The forth coming event on our calendar is the National Anesthesia Day. The theme “Your LIFE… We CARE” was chosen to show that an anaesthestist just does not adorn a mask but we take care of the life of our patients when they undergo anaesthesia or in the intensive care unit. I do hope all of you will come forward and celebrate this day in a grand way as this is not only our chance to educate the public on the role of an anesthetist in patient care but it is also our Golden Jubilee. The Anaesthesia Yearbook 2012-2013 will be launched in conjunction with the National Anaesthesia Day. We will also be coming up with a National logo. Please check your emails for further details. Someone once told me that anesthetists save life but even if they don’t, they improve the quality of life! To all private and public hospitals, I urge you to celebrate this event with us!

Membership and Ovid Online Journal Access

In the second Executive Committee meeting, it was decided that there would be a one-off opportunity valid till the end of this year for all members who have not paid your membership fees especially those who have not paid for more than three years. You can update your membership by just paying for three years and your membership would be current.

The Ovid online journals have been increased from the current three journals to five, i.e. Anaesthesia, Anaesthesiology, the BJA, Current Opinion in Anaesthesiology, Anaesthesia & Analgesia. All the journals are available online. Therefore, update your subscription and get your username and password immediately! To the non-members, join MSA to update yourselves on information and usage of the journals. Ask not what your Society has done for you but what you have done for your Society!

Anaesthesia Yearbook 2013-2014

Associate Professor Basri Mat Nor from International Islamic University (University Islam Antarabangsa Malaysia) has graciously agreed to be the editor of this Yearbook.

Travelling Fellowship Programme – ASEAN & Malaysia

We are in the midst of arranging an educational visit to Laos but we have not finalised the visit as we are still awaiting the itinerary from Laos. If any of you are interested to go to Laos to teach, please contact me. Furthermore, we have started a ‘Reach Out’ programme for Sarawak and Sabah. This is an educational visit. The first visit is by our Chairman, Professor Dr Chan Yoo Kuen, who will be running a one-day session in Kota Kinabalu on 27th August 2013. The target audience are medical officers, nurses and assistant medical officers from all over the state of Sabah.

ASM 2014 - Theme: "Bridging the gap: Evidence meets Experience"

The dates for the ASM 2014 have been changed to 3rd - 6th April due to the Masters’ examination. The venue is Berjaya Times Square Hotel & Convention Center, Kuala Lumpur.

Asian Australasian Congress of AnAesthesiologists (AACA)

The Executive Committee plans to bring more international conferences to our shores in the hope of providing better continuing medical education to our fraternity. We intend to bid for 16th AACA that is scheduled to be held in 2022.

CPD Activities

  • Ultrasound-Guided Peripheral Nerve Blocks, held on 27th August 2013, in Hospital Sultanah Aminah, Johor Bahru, Johor.
  • Obstetrics Anaesthesia Symposium to be held on 25th and 26th October 2013 in Kuala Terengganu, hosted by the Department of Anaesthesia and Intensive Care, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu.
  • 18th Asean Congress of Anaesthesiologists to be held in Suntec City Convention Center, Singapore, from 31st October to 2nd November 2013. (Please do support this conference as we need delegates to perform on the Gala Night!).
  • Nysora 2014 to be held in Kuala Lumpur on the 8th and 9th March 2014.

Please check the website for further updates on events, and mark your calenders.

Participate, partipate please!

CPD completed in 2013

  • TIVA/TCI Workshop on 22nd May, in Hospital Kuala Lumpur, Kuala Lumpur.
  • Ventilator Workshop on 9th and 10th June, in Universiti Malaya Medical Centre, Kuala Lumpur.
  • Obstetrics Anaesthesia Symposium on 6th July, in Tengku Ampuan Afzan Hospital, Kuantan, Pahang.
  • Morpheus 3 on 4th and 5th July, in Hospital Raja Permaisuri Bainun, Ipoh, Perak.

In my next message, I hope to address Subspecialty Training in Malaysia. I look forward to some input and comments from members. Please drop me an email.

Best wishes.

Sushila Sivasubramaniam
President, Malaysian Society of Anaesthesiologists
sushilasivasubramaniam@gmail.com

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Inaugural Say-Wan Lim Oration
at the AOSRA-PM Congress in June 2013 in Kuching, Sarawak
Citation by Professor Ramani Vijayan

Dato' Dr Say-Wan Lim
(1939-2008)

Dr Say-Wan Lim is best remembered for fostering inter-institutional relationships among top medical organisations around the world and putting Malaysia on the map in the arena of international medicine.

Born in Penang, he obtained a scholarship to study medicine in Singapore, and returned to serve the Ministry of Health in 1963. In 1965, he joined the newly created Department of Anaesthesiology in the Faculty of Medicine, University of Malaya (UM), Kuala Lumpur. Dr Lim undertook his anaesthesia training in Liverpool, UK, and became a Fellow of the English and Irish Faculties of Anaesthetists, Royal College of Surgeons. He came back to Malaysia to serve as a lecturer in UM till he left for private practice in late 1969.

However, working as an Anaesthetist only was not enough for Dr Lim. He was a man with boundless energy, a visionary who saw the tremendous benefits of uniting ASEAN Anaesthesia societies and was one of the driving forces in establishing the Confederation of ASEAN Societies of Anaesthesiologists (CASA). The biennial congresses of CASA have been going from strength to strength with ever increasing cooperation between the member countries. This has led not only to academic exchange but has resulted in forging networks and lasting friendships between individual members.

In a similar vein, Dr Lim went on to get a group of likeminded Anaesthetists together from the Asia-Pacific region to establish the Asian Oceanic Society of Regional Anaesthesia (AOSRA) in 1989. AOSRA had a similar vision and goals to the more established American Society of Regional Anaesthesia (ASRA) and European Society of Regional Anaesthesia (ESRA) i.e. to revitalise the science and art of regional anaesthesia in this region. The first AOSRA Congress was held in Taipei in 1991, with Dr Lim as the Congress President and Founder President of the Board of Directors. These biennial meetings have been held ever since, and this current meeting is the 12th in the series.

In 1992, Dr Lim was elected President of the World Federation of Societies of Anaesthesiologists (WFSA), a singular honour as he was only the second Asian and first Malaysian to hold the highest office in this field. He had the skill and leadership for this onerous task, which also put Malaysia on the World Anaesthesia map. Besides this, he had numerous other achievements in his distinguished career, with the notable ones being President of the Malaysian Society of Anaesthesiologists (1974), President of the Malaysian Medical Association (1982-1989), Master of the Academy of Medicine, Malaysia (1984-1990) and President of the Confederation of Medical Associations of Asia and Oceania (1983-1985). He was also not one to hold office in name only, but every organisation that he was involved with came out stronger and more respected.

Despite all his impressive achievements, Dr Lim remained a very approachable man, who would be ever willing to help out yet another committee. According to his close friend, Dr Yeoh Poh Hong, he had the uncanny ability to remember names and this endeared him to both friends and acquaintances. In addition to Anaesthesia and Medicine, he had a lot of other interests. He excelled in several sports including badminton, (Malayan Schoolboys Doubles Champion in 1956 and 1957), squash and golf. His other great love was Freemasonry in which he was passionately involved for the greater part of his life and when he retired.

Life dealt him a double whammy. He was diagnosed with oral malignancy in late 2001 for which he underwent treatment. Having survived that he was diagnosed with another unrelated malignancy of the lung which eventually overwhelmed him. Throughout his ordeals he maintained an inner strength and accepted his fate with quiet dignity.

Dato’ Dr Lim is survived by his wife, Jeannie Lim, who stood by him through all the good and bad times. His family who includes three sons and two grandchildren, got to see a lot more of him when he retired.

With his passing in 2008, Malaysia has lost a champion. But we will be forever indebted to him for his vision, passion and gumption to take up so many challenges. Our thoughts are with Datin Jeannie.

The Say-Wan Lim Oration at this and all subsequent AOSRA-PM Congresses, has been established in his memory as a tribute to his tremendous contributions to the Society.

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12th Asian & Oceania Society of Regional Anaesthesia & Pain Medicine Congress
19th to 22nd June 2013
by Dr Nora Idris
Consultant Anaesthesiologist, Hospital Umum Sarawak, Sarawak, Malaysia

Kuching recently hosted the 12th Asian & Oceanic Society of Regional Anaesthesia and Pain Medicine Congress from 19th to 22nd of June 2013. This was the second time that Malaysia played host to this regional meeting; the first one was in 1997. This year’s congress incorporated the Annual Scientific Meeting of the Malaysian Society of Anaesthesiologists (MSA), the College of Anaesthesiologists and the Malaysian Association for the Study of Pain (MASP). This meeting was indeed special because it had coincided with the Golden Jubilee celebrations of the MSA as well.

In tandem with the theme “Exploring the World of Regional Anaesthesia & Pain Medicine”, participants had the opportunity to hear lectures delivered by eminent speakers coming from almost all the continents! Nearly 900 delegates congregated in Kuching during those few days. This meeting was officially opened by Dr Chin Zin Hing, the Sarawak State Deputy Medical Director, on behalf of Datuk Dr Noor Hisham bin Abdullah, the Director-General of the Ministry of Health. Among those present for the meeting were also Dr David J Wilkinson (President of WFSA) and Dr Susilo Chandra (President of AOSRA).

Over the four days, the Scientific Committee had managed to put together five plenary lectures, 20 symposium sessions and two workshops. In fact, another six pre-congress workshops were also conducted; four at the congress venue in Pullman Kuching, and another two at Sarawak General Hospital. Many pharmaceutical companies had also taken the opportunity to showcase their products at the exhibition booths.

The highlight of the event was probably the Gala Nite which was appropriately themed “Rendezvous in Gold” to commemorate the Golden Jubilee of MSA. The evening was indeed a special one as we were able the witness the launching by Dr Sushila Sivasubramaniam, the current MSA President of the much awaited History of Anaesthesia in Malaysia book. As usual, winners of the MSA Award and MSA-AstraZeneca Young Investigator Award, as well as the winner for the best poster, were announced on that night. The glittering night was filled with music and dances which went late into the night… and there may be some who dreamt of returning to the 13th AOSRA meeting in Thailand, in 2015.

 

 

 

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Perak Anaesthesia and Intensive Care Update 2013 (Morpheus 3)
by Dr Sukhminder Kaur and Dr Chia Lip Han
Medical Officers, Department of Anaesthesia and Critical Care
Hospital Raja Permaisuri Bainun, Ipoh, Perak

The Perak Anaesthesia and Intensive Care Update 2013 (Morpheus 3) was successfully held from the 4th to 5th of July 2013 at the MH Hotel Ipoh, Perak. It was organised by the Department of Anaesthesia and Critical Care, Hospital Raja Permaisuri Bainun, Ipoh, Perak, and Malaysian Society of Anaesthesiologists for the Northern region. The aim was to improve the daily practice of our doctors and paramedics and to equip them with updates for better quality care for our patients. It saw an overwhelming response with more than 300 participants for both the days.

Workshops for doctors and paramedics were held separately on the morning of the 4th of July, followed by lectures in the afternoon. The interactive workshops were ultrasound in critical care, ultrasound for regional anaesthesia, presentation skills, pain management and continuous renal replacement therapy. A survey showed that overall participants were more than satisfied with the way the workshops were held. In fact, they voiced that they wanted to rotate through all the workshops the next time. The afternoon lectures by imminent speakers were regarding current and important issues in the daily practice for anaesthesia and ICU.

The much anticipated anaesthesia night themed ‘Disney Night’ had an ecstatic crowd. The performances were by our very own talented nurses, medical officers and specialists. The crowd was also entertained by a stand up comedian who had people laughing in glee all the way home that night. More than half the crowd won amazing lucky draw prizes.

The next day, there were talks by distinguished speakers who were experts in their fields. The official opening ceremony was done by the Pengarah of Hospital Raja Permaisuri Bainun, Ipoh, Perak, YM Dr Raja Lope Ahmad Bin Raja Ariffin. The morning started with a talk by Dr Lim Wee Leong who spoke on ‘Memory Loss After GA’. Then it was ‘Fluid Challenges And Update In ICU’ by Dr Kamal Bashar Abu Bakar. This was followed by ‘Everything About Radiological Imaging’ by Dr Mohd Shaffie Baba, ‘Acute To Chronic Pain’ by Dr Devanandhini Krishnan, ‘End Of Life’ by Dr Siti Rohayah Sulaiman and ‘Stress Management’ by Dr Salhana Mohd Wazir.

Following a scrumptious lunch, the afternoon session had two talks. Dr Usha Nair spoke on ‘The Child With A Syndrome’ and Ms Sue Foong explained about modes of ventilation.

The participants were very contented and happy with the way the update was organised as shown by the evaluation survey forms. To quote the Organising Chairperson of the update, Datin Dr Najah binti Tan Sri Haji Harussani, “We believe that this programme will help us gain practical experience, as well as updates in our practice in the field of anaesthesiology and critical care”

 

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Hospital Sungai Buloh Anaesthesia Night Report
by Dr Anantha Ram, Hospital Sg Buloh, Selangor

On the 15th of May 2013, exceeding all hopes and expectations, the first ever Hospital Sungai Buloh Anaesthesia Night kicked off to a great start with over 50 Anaesthesia Department staff and their family members gathering at the Tropicana Golf and Country Club, Selangor.

The evening began with guests being treated to a scrumptious dinner, complete with dessert and all the trimmings while two ICU staff did the honour of serving as the hosts for the night, entertaining guests with their humour, wit and anecdotes that were much appreciated.

With the theme being “Movie Night” it was indeed a pleasant sight to witness doctors, nurses and other medical staff trade in their usual blue scrubs for more colorful and dapper outfits while some dressed in-line with the theme, putting on display their best rendition of a movie character.

In his speech, Head of Department, Dr Lim Wee Leong, thanked all guests for making the night a successful one and expressed his hopes of this event being made into an annual one. He also took the opportunity to greet all guests at their respective tables, even stopping to pose for a photo opportunity.

Nurses, doctors and even guests took to the stage to entertain, some through group dance performances while others opted for solo performances. The highlight and most memorable event of the night however, was the performance by Head Intensivist, Dr Shanthi Ratnam and Dr Premala. They clearly proved that their talents weren’t only restricted to the ICU settings as their song performances garnered them an overwhelming applause and roar from the crowd.

In between performances, the lucky draw prizes were announced. It was safe to say that no one went home empty handed that day. The best dressed male of the night was “Justin Timberlake” who appeared in the form of Anaesthesia Medical Officer, Dr Siah while the best dressed female was so well disguised no one could tell who she really was.

The evening culminated with all the guests on stage, shuffling and dancing to the famous song, “Gangnam Style”.

All in all, the inaugural Anaesthesia Night was an excellent opportunity for the Anaesthesia Department team to gather outside the vicinity of the hospital and indulge in delectable food and enthralling performances whilst enjoying a great chat.

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Obstetric Anaesthesia Symposium
by Dr Asmarawati Mohamad Yatim, Head of Department, Hospital Tengku Ampuan Afzan, Kuantan, Pahang

A day symposium, entitled Obstetric Anaesthesia Symposium was conducted on the 6th July, 2013 in Kuantan. It was a successful event in collaboration with the Department of Anaesthesiology & Intensive Care, Hospital Tengku Ampuan Afzan (HTAA) Kuantan, the Special Interest Group in Obstetric Anaesthesia and the Malaysian Society of Anaesthesiologist.

The symposium was officiated by Dr Norhizan Bin Ismail, Director, from the Pahang State Health Department, and was attended by 216 doctors and paramedics from Pahang, Terengganu, Kelantan, Kedah, Selangor, Sabah and Sarawak. The participants were treated to talks delivered by the country’s prominent obstetric anaesthesiologists; Prof Chan Yoon Kuen, Dr Mohd Rohisham bin Zainal Abidin, Dr Nadia Mohd Nor, Dr Thohirah Abdul Razak and Dr Norliza Mohd Nor. The topics covered the anatomy and physiology, the obese parturient and the bleeding obstetric patient. There were two forums discussed in detail on topics regarding labour analgesia and anaesthesia and postoperative pain relief for LSCS. Participants were given the opportunity to be involved in the discussion. This symposium highlighted the recent practice in managing the parturient.

The symposium ended at 5.00 pm.

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Malaysian Society of Anaesthesiologists & College of Anaesthesiologists Scientific Meeting and Annual General Meeting 2013
by Dr Kok Meng Sum

The Annual General Meeting (AGM) of the Malaysian Society of Anaesthesiologists (MSA) and the College of Anaesthesiologists this year was held in conjunction with a short Scientific Meeting on 7th April 2013 in the T J Danaraj Auditorium, Medical Academies of Malaysia, Kuala Lumpur. The Scientific Meeting this year focused on a very important issue in the medical fraternity, the most feared but less explored aspect – Medico-Legal Issues in Anaesthesia.

Sunday morning saw the conference room filled with over 30 members from all over the country as the session began with an inspiring lecture by Dato’ Dr Mohamed Hassan Mohamed Ariff on ‘Medico-Legal Issues in Anaesthetic Practice’ chaired by Datin Dr V Sivasakthi, President of the Malaysian Society of Anaesthesiologists. Dato’ Dr Hassan is a prominent figure in the anaesthesia family. He is the Head and Senior Consultant Anaesthesiologist in the Cardiac Anaesthesia Unit in our National Heart Institute. He also holds a Degree in Law.

The lecture was very well-received, and immediately set the tone for discussion among the participants about their concerns on this issue, as well as on the new guideline on ‘Consent For Treatment Of Patients By A Registered Medical Practitioners’, which was adopted by the Malaysian Medical Council early this year. This guideline introduces the period of validity of consent which is now to be 24 hours.

The meeting continued with Mr Dhinesh Bhaskaran, a lawyer with partnership at the law firm Shearn Delamore & Co, introducing to us ‘An Update on Consent in Anaesthesia’ which was met with enthusiasm from the audience. Mr Dhinesh has vast experience dealing with medical malpractice litigation and was admitted in 1990 to the Barrister-at-Law, Gray’s Inn and in 1992, as Advocate and Solicitor in the High Court of Malaya. He has been featured in a number of reported cases in various areas of the law. The audience was enthralled with an in-depth perspective into issues concerning consent in anaesthesia, and then ventured into other medico-legal issues in anaesthesia from the law point of view.

Especially notable was the ardent discussion and conversation generated by the talks. There were few signs of slowing down as presenters and audience debated points and presentations. The general consensus was to revise the consent guideline in the respective hospitals to be in sync with the Malaysian Medical Council. This will present its own set of challenges.

The meeting continued with the Annual General Meeting of the Malaysian Society of Anaesthesiologists which was preceded by a short break. Datin Dr V Sivasakthi led the meeting with announcements of the society’s activities for the last one year, updates of the fee schedule, presentation of the Statement of Accounts for the year that ended on the 31st December 2012 by the Treasurer, Datuk Dr V Kathiresan, and the election of the new Committee Members for the year 2013-2014.

Dr Sushila Sivasubramaniam took over as the new President for the year 2013-2015.

The board defined a number of agreements. One of them, which were met with heated discussion was the passing of the Tabled Resolution that the MSA mandates the Executive Committee to purchase a property of up to a maximum value of two million ringgit, and authorises them to take all the appropriate and necessary action for the purchase of this property.

This was followed by the AGM of the College of Anaesthesiologists with the election of new Office Bearers.

The AGMs concluded in the early afternoon with a small get-together during lunch.

All in all, this meeting was successful at both the scientific and social levels.

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Ventilation Care Workshop
by Dr Vineya Rai and Dr Wong Kang Kwong, Department of Anaesthesia, University of Malaya, Kuala Lumpur

On the 8th and 9th of June 2013, the Department of Anaesthesia, University of Malaya, organised the abovementioned workshop at the new South Wing block of Universiti Malaya Medical Centre (UMMC), in collaboration with the Critical Care Section of MSA.

We received overwhelming response from medical officers from various states under the Ministry of Health (MOH), including Sarawak. As we could only accommodate 100 participants, we had to reject many. We apologise to those who showed great enthusiasm but were rejected due to limited seats. We had 40 participants from UMMC and 60 from the MOH hospitals.

The two-day workshop consisted of lectures and dedicated skills stations for participants to have a “hands-on feel” on various aspects of ventilation. The skills stations were High Frequency Oscillatory Ventilation (HFOV), Non-Invasive Ventilation (NIV), troubleshooting ventilator dyssynchrony and various aspects of ventilator settings.

The lectures and skills stations were conducted by a group of prominent speakers. The speakers were Prof Dato’ Dr Patrick Tan Seow Koon (UMMC), Prof Charles Wiener (Perdana University/Johns Hopkins University), Dr Gerald Chua (Alexandra Hospital, Singapore), Assoc Prof Dr Basri Mat Nor (International Islamic University Malaysia), Michael Rodda (Australia), Kien Kong (Singapore) and Sue Foong (Malaysia).

The event commenced with a warm welcome by the Organising Chairman, Dr Vineya Rai, and officiated by the Head of Department of Anaesthesia, UMMC, Professor Dr Marzida Mansor. This was followed by lecture sessions in the morning and skills stations in the afternoon. The next day consisted of a full morning of lectures.

We also had trade exhibition booths from the industry to showcase their products used in ICU. A total of 15 booths were taken. This was made possible with the availability of a big floor space on the 13th floor of our auditorium complex.

The event was co-sponsored by three industry partners: Drager, Covidien and Schmidt BioMedTech.

Feedback from the participants was very positive. The success of this event has motivated us to make this inaugural event a yearly affair.

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TIVA/TCI Workshop Hospital Kuala Lumpur 2013
by Dr Aizatul Isla Abdul Latib, Anaesthesiologist, Hospital Kuala Lumpur, Kuala Lumpur

For the second consecutive year, the Department of Anaesthesiology of Hospital Kuala Lumpur, has successfully organised a full-day course on Total Intravenous Anaesthesia and Target Controlled Infusion (TIVA/TCI). It was held on the 22nd of May 2013 at the General Operating Theatre Complex of Hospital Kuala Lumpur. This was a joint collaboration with Abbott Laboratories (M) Sdn Bhd, Malaysia Healthcare Sdn Bhd (Maycare), and Malaysian Society of Anaesthesiologists.

We had a total number of 29 participants and the target group was medical officers in anaesthesia departments and anaesthesia trainees. The participants were divided into five smaller groups for them to have better hands-on experience with our guest speaker, Dr Muhammad Maaya, a Senior Consultant Anaesthesiologist from Hospital Universiti Kebangsaan Malaysia (HUKM).

Our day started at 7.30 am with registration and continued with a short lecture on TIVA & TCI covering the history, pharmacological aspects of the drugs used in TIVA/TCI and Dr Muhammad’s personal experience on using TIVA/TCI for more than ten years. After a quick breakfast, we proceeded to the GOT complex for a step-by-step explanation starting from induction, maintenance and extubation techniques with Dr Muhammad. We had a wide range of patients selected for the workshop from general orthopedics, spine, ENT, dental and general surgical patients. In between the transition period, the participants were exposed to the various selections of TIVA and TCI machines and a short running video lecture on TIVA by the Abbott and Maycare representatives.

A delicious lunch was provided by the kind representatives from Abbott Laboratories (M) Sdn Bhd. Three prizes were given to highest scorer in MCQ at the end of the course. The workshop ended at around 4.00 pm. By the end of the day, most of the participants were satisfied with the organisation and content of the workshop. Feedback forms were filled, certificates were given out and the workshop ended on a satisfying note.

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SSC 5C Elective Assessment - Report
by Natasha Budhwani, London School of Medicine and Dentistry

Destination: Hospital Kuala Lumpur, Kuala Lumpur
Subject: Anaesthesia

  1. Describe the pattern of disease/illness of interest in the population with which you will be working, and discuss this in the context of global health. What are the common surgical procedures requiring general anaesthesia in Kuala Lumpur and how these differ to the UK?

From the beginning, I realised that the structure and format of the healthcare delivered in Malaysia is very similar to the UK.

As in the UK, general anaesthetic are used for painful or long procedures, as well as for procedures where it may be safer for the patient to remain unconscious and decision to use general anaesthesia is left at the anaesthetist’s discretion based on the patient’s medical history and the procedure to be carried out.

In terms of common surgical procedures requiring general anaesthetics, I did not note any obvious differences to the UK.

In Hospital Kuala Lumpur, one of the largest departments is that of Anaesthesia and Intensive Care. The number of anaesthetics administered increases annually with a total of 24,000 cases last year, providing services for a large number of patients throughout the country, functioning as a national referral centre.

  1. Describe the pattern of health provision in relation to the country in which you will be working and contrast this with other countries or with the UK. (Methods of admin of general anaesthesia in Kuala Lumpur and how these differ to the UK)

During my elective posting, I noted similarities in the methods of administration of general anaesthesia between the UK and Malaysia.

The ‘Anaesthesia Machine’ used to deliver the anaesthesia is universal and therefore, works exactly the same in Malaysia as in the UK. I also found that the labels and monitors were all in English and therefore, it wasn’t difficult for me to interpret values.

I found very little difference between the drugs used in Malaysia in comparison to the UK. Anaesthetic drugs were administrated using the intravenous route in most cases and I was told that the inhaled route is also used, if obtaining intravenous access is difficult, and in paediatric cases.

The main induction agent used in Malaysia is Propofol, the same as in the UK. I noted that the principle was the same. Besides anaesthesia, analgesia and a muscle relaxant were also given, thus, completing the universal triangle of anaesthetics, something that had been taught to me during my anaesthetic placement at Colchester General Hospital.

However, I noticed that unlike in the UK where there is a separate adjoining anaesthetic room to the theatre, the patient here is brought into the surgical theatre and to be anaesthesised in the same room where the surgery will take place. After the surgery, the patient is taken to a room at the centre of all the theatres.

On the whole, I found no major differences in the appearance of the theatre or delivery of the anaesthetic services.

  1. Health related objective: Describe the layout of healthcare in Malaysia compared to the UK (NHS systems including accessibility and costs.

The healthcare system in Malaysia is similar to the UK and is made up of both the public and private sectors. However, the government healthcare system is not free like the UK. Only 5% of the government’s budget is allocated to the government healthcare system and the remaining is to be paid by the public. Although the public are required to pay for their healthcare, I was given the impression after having spoken with the healthcare professionals that the prices are affordable which means it is accessible to the majority of the citizens in the country.

The hospital of Kuala Lumpur being a government-funded hospital means that it is extremely busy as it provides access to all its specialities. For this reason, the Malaysian government is constantly working hard to improve and develop the healthcare system in the country due to the country’s life expectancy rising each year. It was interesting to be made aware that both the governmentrun healthcare system and the private healthcare system work alongside each other in Malaysia. The private healthcare is much more expensive, and only those who can afford the private healthcare, will do so. This usually includes those Malaysians citizens who have a higher income and also tourists who come to visit Malaysia.

Furthermore, something which I found rather interesting, was that part of the hospital’s budget goes towards paying for staff meals. During various times of the day, different members of the team would be having breakfast or lunch after a few hours in theatre. I felt very welcome and part of a big community where I enjoyed speaking to different healthcare professionals. This was a nice change in comparison to the UK where individuals would have to organise their own lunches in different parts of the hospital.

  1. Personal/professional development goals. Must also include some reflective assessment of your activities and experiences. Communicating and developing rapport with patients from different backgrounds including non- English speakers. Reflecting on experiences of effective communication where they are language barriers.

During the anaesthetics placement, I found that this objective was difficult to address. This was due to the high patient turnover and most of the time that was spent with the patients, was when they were under general anaesthesia. However, before the anaesthetic was administered, I was given the opportunity to interact with several patients.

With regards to communication, I did not encounter any problems with the doctors and nursing staff, as they were fluent in English. However, the majority of the patients spoke Malay only. I was able to overcome this language barrier by asking the doctor or nurse to translate; this was a good experience because it allowed me to practise, taking a short and concise history.

Besides this, I also manage to communicate using broken English with a few words of Malay that I managed to pick up. I also found that the communication skills that had been taught to us during the course proved to be very useful. These included making the right non-verbal sounds and using appropriate body language. This made me realise the importance of these skills and I will carry these forward to when I am working.

The general patient population were very friendly and extremely accommodating. Therefore, I found it relatively easy to build rapport with the patients. It was interesting to listen to the patients’ experiences and I found that they were often very interested and keen to hear about my experiences and the UK, in general.

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Unforgettable Souvenirs of My Travelling Fellowship in Malaysia
by Dr Nguyen Toàn Thang
Lecturer, Anaesthesia and Critical Care Department, Hanoi Medical University, Bachmai Hospital, Hanoi, Vietnam

My name is Nguyen Toàn Thang, an Anesthesiologist and Lecturer at Hanoi Medical University and Bachmai Hospital, Hanoi, Vietnam.

In order to enable anaesthesiologists from the Asian region to exchange their knowledge and expertise as well as to give them opportunity to visit the respective countries and to learn about the current healthcare scenario and anaesthetic services, Malaysian Society of Anaesthesiologists has initiated an Asean Travelling Fellowship. Fortunately, I received this fellowship. This is the first time I have been to Malaysia, and it is an unforgettable and useful trip in my life.

Firstly, I had three days for participating in AOSRA conference in Sarawak, Kuching, where I have met and made friends with a lot of anesthesiologists and pain specialists from around the world. I have updated my concerns about regional anaesthesia and chronic pain. In Kuching, I also had many excellent experiences during the Faculty Dinner (20th June 2013), AOSRA-PM Gala Night and MSA 50th Golden Jubilee Celebrations (21st June 2013), with a lot of delicious and traditional Malaysian food, and colourful and impressive events (gave me more knowledge about the history of development of the Malaysian Society of Anaesthesiologists).

Secondly, I was most impressed by the professional skills and the excellent collaboration offered by anaesthesiologists and other staff in the theatre and recovery room of Hospital Kuala Lumpur, where I spent my one-day visit. This was a good opportunity for me to share opinions and knowledge with my young Malaysian colleagues who are experts in anaesthesia, as well as going shopping and visiting some famous places in Malaysia.

Finally, I would like to express my great thanks to the Malaysian Society of Anaesthesiologists, Dr Kok Meng Sum and Ms YM Kong who gave me such wonderful experiences in Malaysia. I hope that more Vietnamese and Malaysian doctors will have Travelling Fellowhship like me.

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Anaesthesiologists Outside the OT
by Dr Gunalan Palari Arumugam

We have often talked about the differing roles that anaesthesiologists play outside the OT environment, i.e in the radiology suite, endoscopy room and critical care transportation, and so on. This series of articles is not going to touch on that, rather, this space is a platform for our anaesthesiologists out there to share some of the more interesting stuff that they do away from the daily grind of intubating and ventilating patients. A kind of sneak peek into their lives outside the operating theatre.

I spoke to two of our colleagues out there and got them to share with me their passion for running, especially in half and full marathons, which I am sure, a number of us out there are doing, on a regular basis.

There is a joke that equates us with members of the Bomb Squad team. Both are good at defusing difficult situations and are generally calm and collected when things are tense. We differ from the Bomb Squad in one important aspect. If you see a member of the bomb squad running, they are running away from definite disaster. If an anaesthesiologist is running in a hospital, they are running helter skelter towards the disaster...

Jokes aside, for those who have had the pleasure of working at some of the major tertiary hospitals of the country, running when on call is a norm. Dr Yani, currently at the KPJ Sentosa Medical Centre, Kuala Lumpur, remembers the good old days of being the specialist on call, covering all the different OTs in the vast grounds of Hospital Kuala Lumpur.“ Typically the running starts in the morning and will go till late evenings and just when you are about to put your leg up for a deserved break, you will get the dreaded call from your most senior registrar who just failed to intubate someone. So, off you go running. Since joining the private sector, I had lots of free time on my hands, or rather legs, so I decided to make good use of it,” he says. “I was never active at school and only started taking it seriously in 2012. The person who inspired me most was my 60 year-old orthopaedic surgeon, who outruns me on most days, so I thought if he can do it, I have no excuses. With that, the enthusiasm for running actively started, and to date, I have done a number of runs, among which, the one I am most proud of right now is the Gold Coast marathon that I did it in less than 4 hours”. For the uninitiated, the current World Record stands at just above 2 hours, so well done Dr Yani!

Another newcomer to taking running as a serious hobby is Dr Nordin who is currently practising in Mahkota Medical Centre, Melaka. He says, “I started only in 2013, doing it just for fun over the weekends but am now concentrating on the short distances such as the Seremban 10 km run. So far, since I have paced and prepared myself well, I have not encountered any serious injuries. In the future, I am planning to take part in the Standard Chartered KL Marathon, as well as the Putrajaya Night Run and the Powerman 2013.”

I am sure many of us out there have treadmills and like to run in the comfort of our homes while watching TV. When asked what’s their preference both Dr Yani and Dr Nordin concurred that outdoor running is far better. “You get to enjoy the fresh air (except during the haze) and scenery, and of course the treadmill or dreadmill to me, gets you nowhere,” says Dr Yani.

So, for those who have always wanted to put on the running shoes but have procrastinated on actually doing it, hope these stories from our colleagues help you to “just do it”. As Dr Nordin puts it, “Just put on your shoes and run. Don’t worry about the nitty gritty stuff, just run and everything else will sort out by itself.”

I guess for me it’s time to look for the running shoes that is neatly tucked away somewhere in my closet. At the very least, it might help me reduce my oxygen debt the next time I get called to attend to an emergency.

Till the next article, cheers!

P.S. Please direct any comments or suggestions for future articles to me at gunalan73@yahoo.com. All comments are welcome.

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Book Launch: History of Anaesthesia in Malaysia
by Dr A I Gurubatham
Chairman, History of Anaesthesia in Malaysia Committee

The book, “History of Anaesthesia in Malaysia”, was launched on 21st June 2013 at the 12th Asian & Oceanic Society of Regional Anaesthesia & Pain Medicine at Colosseum 1, Pullman Kuching, Sarawak.

After attending a packed programme on that day, more than 800 delegates gathered together for the Gala Night and Golden Jubilee Celebration at the above venue to relax and enjoy the evening. As it was the 50th Anniversary of the Malaysian Society of Anaesthesiologists, everyone donned gold and black attire for the celebration.

When the President of the Malaysian Society of Anaesthesiologists, Datin V Sivasakthi, wrote to me to think and write about the history of anaesthesia in Malaysia, I took the suggestion seriously and pondered on how to produce this book. It was decided to have in the small committee, Dato’ Dr A Damodaran and Prof Datuk Dr A E Delilkan. It was a monumental task but with steel determination, the book was produced. Dr R Gopalkrishnan, the first Secretary cum Treasurer of the Society, was of tremendous help.

After the presentation of the Awards at the Gala Night, a brief history of the Society was touched upon and the milestones it had gone through in the last 50 years to reach the present state was mentioned:

  1. The growth of the Society.
  2. The First Malaysian Congress in 1973.
  3. The birth of the ASEAN Congress of Anaesthesiologists.
  4. Dato’ Dr Lim Say Wan in the World Federation of Societies of Anaesthesiologists.
  5. Ties with the Faculty of Anaesthesiologists, Royal Australasian College of Surgeons.
  6. The ASEAN Journal of Anaesthesiology.
  7. The Annual Scientific Meetings, etc.

The first Secretary cum Treasurer had this to say about the book, “History of Anaesthesia in Malaysia reflects the dauntless dedication and work put in by Dr Alex I Gurubatham and Dato’ Dr A Damodaran. They have gathered, compiled and edited extensive historical material in this commendable volume which is testament to the hopes and foresight envisaged by the convenors of the Society”.

Dato‘ Dr Arumugam Ganendran, the first Chair Professor of Anaesthesiology in 1975, wrote from Brisbane, Australia, where he currently resides, “It is clear from the book that Dr Alexander Isaac Gurubatham and Dato’ Dr A Damodaran have relentlessly pursued this (writing the book), seeking information from unusual sources, interviewing many personnel and going through numerous photographs. In short, they have left no stone unturned”.

The book on the History of Anaesthesia in Malaysia was embedded in ice and all the Past Presidents of the Malaysian Society of Anaesthesiologists were invited on stage to witness the book being delivered, by the breaking of the ice, by the President of the Society, Dr Sushila Sivasubramaniam.

Producing this book on the History of Anaesthesia in Malaysia was no easy task and the authors of the book are very grateful to a number of people: Emeritus Prof Datuk Dr A E Delilkan, Dr R Gopalkrishnan, Brig Gen Dato’ Dr Jegathesan Singaravelu, Prof Dr Y K Chan, Prof Karis bin Misiran, Assoc Prof Dr Norshidah Abdul Manap, Dato’ Dr A Ganendran, Dr Lily Ng, Dr Mohamed Namazie Ibrahim, Dr Norzalina binti Esa and many others.

The authors also know that there are gaps in some areas and these have been left out as the files and documents related to them have been unobtainable, inaccurate or lost.

Details of the Office Bearers of the Society from 1979 to 1992 are not available. The authors would like to appeal to members who have documents for these to send them to the Secretariat, Malaysian Society of Anaesthesiologists or email to alexgurubatham@gmail.com.

Any other suggestions on the book are welcome.

All members of the Society are eligible for a free copy of the book. Please contact the Secretariat.

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Message from the President of the College of Anaesthesiologists, AMM

Hi Friends,

I have returned from Dublin and want to share the results of my meeting with the CEO and the Post-Graduate Dean of the College of Anaesthetists of Ireland (CAI).

The background behind this meeting is that we wanted to find an alternative pathway for doctors who want to specialise in Anaesthesia and are unable to do the Master’s programme in Malaysia for various reasons. The situation became rather bleak when the usual FANZCA programme was withdrawn from Malaysia. It was rather timely that we took the opportunity to meet with the President and Chief Executive Officer (CEO) of CAI in 2012, to discuss future possible liaison pertaining to postgraduate, specialist and sub-specialist examinations and training.

The Primary FCAI was set to be conducted here but we had to wait for further news on the recognition of our training in Malaysia.

Therefore in June, I met them again and a few interesting decisions were made:

  1. One can sit for the MCQ Examination in Perdana University in Kuala Lumpur. This exam is held three times a year, in January, June and September, and exact dates can be found in their website at www.anaesthesia.ie.
  2. CAI is looking at bringing the OSCE/ SOE (viva) to Perdana in 2014, if there are sufficient numbers of candidates.
  3. There is a plan to have a weekend intensive course in Kuala Lumpur before the OSCE/SOE. This will assist the candidate in preparing for the exams.
  4. The Primary FCAI has now been given full Membership Status by the College, and is now designated as Membership of the College of Anaesthetists of Ireland (MCAI).
  5. You can work in any hospital under a Head of Department who will attest your work in the Department of Anaesthesia. There is no requirement for an accredited Hospital yet.
  6. You need to go to Ireland only to sit for the Final Fellowship exams. There is no necessity now for one to work in Ireland.

Well, I am attaching an FAQ prepared by CAI for further details.

The President, Dr Ellen O’ Sullivan and the CEO, Mr Fintan Foy, will be coming to Malaysia in October 2013, and I hope to arrange a meeting with them, so that you can ask questions directly.

FAQs:

Who is eligible for the Membership CAI MCQ?

Any Medical Practitioner with a primary medical qualification acceptable to the Irish Medical Council (IMC), will be eligible to sit for the MCAI MCQ Examination.

For a list of acceptable qualifications, please log-on to:
http://avicenna.ku.dk/database/medicine

What is the structure of the examination?

The MCQ paper is made up of three 1-hour papers.

  • Pharmacology
  • Physiology
  • Clinical Measurement

Is there negative marking?

One mark is awarded for each correct answer. Negative marking is not used in the MCAI MCQ, i.e. a mark will not be lost for an incorrect answer. A question booklet and an optical mark sheet will be provided to record your answers; Candidates who make ambiguous marks on their optically read sheet will not be given the benefit of the doubt.

How long is the result valid for?

A pass in the MCQ is valid for three years from the date of the successful examination towards the OSCE/SOE, after this time the MCQ must be retaken.

The successful candidate’s exam numbers are published on the College website within one week of the examination. All candidates will receive their results by post.

What are the eligibility criteria for the MCAI Objective Structured Clinical Examination (OSCE) and the Structured Oral Examination (SOE)?

An individual is eligible to sit for the MCAI OSCE/SOE who fulfils the following criteria:

  • Is a Medical Practitioner with a primary medical qualification acceptable to the Irish Medical Council (IMC), will be eligible to sit for the OSCE/SOE?
  • Is registered with the Irish Medical Council or other national medical registration body?
  • Has been employed as an anaesthetist for 12 months, prior to the date of the particular exam applied for.
  • Has been successful in the MCAI MCQ.

If successful in the Membership exam, can I work in Ireland?

No. You must be registered with the Irish Medical Council to work in Ireland. The CAI cannot help with this process. The IMC can be contacted at http://www.medicalcouncil.ie/

If successful in the Membership exam, can I join the CAI training programme?

No. You must be registered with the Irish Medical Council to work in Ireland. The CAI cannot help with this process. The IMC can be contacted at http://www.medicalcouncil.ie/. Applications open in Autumn for posts in July. Please visit our website www.anaesthesia.ie/training for information on how apply for the training programme.

Do I need to be in a training post to sit for the Membership exam?

You do not need to be in a training post. You must be employed as an anaesthetist for 12 months prior to your exam application.

If I passed the Primary/OQE examination; can I use MCAI after my name?

Anyone successful in the Primary/OQE FCAI from 1998 onwards, is eligible to apply for an ad eundem MCAI award. You must be conferred before you can use the post nominal MCAI.

If I have an exempting qualification (e.g FCPS) for the Final FCAI, can I be awarded the MCAI?

No. The MCAI is awarded by examination only.

Datin Dr V Sivasakthi

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